An Evaluation of Antidepressants in Rheumatic Pain Conditions

Rani, P. Usha; Naidu, M. U. R.; Prasad, V. S. S. V.; Rao, T Ramesh Kumar; Shobha, J. C.

doi:10.1213/00000539-199608000-00029

Cited by 46 publications

(13 citation statements)

References 17 publications

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“…Withdrawal due to adverse effects was not necessary. Reported adverse effects of amitriptyline were mainly dizziness, constipation, headache, and palpitations (13). Similarly, Bendtsen et al compared the treatment of amitriptyline (75 mg/day), citalopram (20 mg/day), and placebo in 40 patients under crossover conditions.…”

Section: Resultsmentioning

confidence: 99%

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Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis

et al. 2017

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BackgroundAntidepressants are widely used in the treatment of chronic pain. Applied doses are lower than those needed to unfold an antidepressive effect. While efficacy of antidepressants for chronic pain has been reported in large randomized-controlled trials (RCT), there is inconsistent data on adverse effects and tolerability. We aimed at synthesizing data from RCT to explore adverse effect profiles and tolerability of antidepressants for treatment of chronic pain.MethodsSystematic literature research and meta-analyses were performed regarding side effects and safety of different antidepressants in the treatment of chronic pain according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Center for Biotechnology Information library and MEDLINE were searched. Randomized placebo-controlled trials were included in quantitative data synthesis.ResultsOut of 1,975 screened articles, 33 papers published between 1995 and 2015 were included in our review and 23 studies were included in the meta-analyses. A higher risk for adverse effects compared to placebo was observed in all antidepressants included in our analyses, except nortriptyline. The most prevalent adverse effects were dry mouth, dizziness, nausea, headache, and constipation. Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline showed the highest placebo effect-adjusted risk of adverse effects. Risk for withdrawal due to adverse effects was highest in desipramine (risk ratio: 4.09, 95%-confidence interval [1.31; 12.82]) followed by milnacipran, venlafaxine, and duloxetine. The most common adverse effects under treatment with antidepressants were dry mouth, dizziness, nausea, headache, and constipation followed by palpitations, sweating, and drowsiness. However, overall tolerability was high. Each antidepressant showed distinct risk profiles of adverse effects.ConclusionOur synthesized data analysis confirmed overall tolerability of low-dose antidepressants for the treatment of chronic pain and revealed drug specific risk profiles. This encompassing characterization of adverse effect profiles might be useful in defining multimodal treatment regimens for chronic pain which also consider patients’ comorbidities and co-medication.

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Section: Resultsmentioning

confidence: 99%

“…Withdrawal due to adverse effects was not necessary in both groups. Reported adverse effects of fluoxetine were mainly nausea, dizziness, headache, palpitations, edema, gastritis, loss of appetite, and breathlessness (13). …”

Section: Resultsmentioning

confidence: 99%

Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis

et al. 2017

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“…25 Twenty-seven patients had low back pain, 16 had osteoarthritis, 8 had fibromyalgia, and 8 had rheumatoid arthritis. After 4 weeks, compared with the placebo group, there was a significant reduction in pain intensity scores and pain relief scores for those treated with amitriptyline (p Ͻ .05) or fluoxetine (p Ͻ .001).…”

Section: Chronic Painmentioning

confidence: 99%

The Efficacy of Selective Serotonin Reuptake Inhibitors for the Management of Chronic Pain

1997

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OBJECTIVE:To assess the effectiveness of selective serotonin reuptake inhibitors (SSRIs) in the management of chronic pain. METHODS:Randomized, controlled trials of SSRIs in the management of chronic pain were identified by searching MEDLINE from 1966 to 1997 and by contacting the manufacturers of SSRIs available in the United States. MAIN RESULTS:Nineteen studies were identified, including 10 on the treatment of headache, 3 on diabetic neuropathy, 3 on fibromyalgia, and 3 on mixed-chronic pain. SSRIs were consistently helpful for mixed-chronic pain. Results were conflicting for migraine headache, tension headache, diabetic neuropathy, and fibromyalgia. T he clinical management of chronic pain remains a challenge. Despite advances in pain research and clinical treatment, rates of disability due to chronic pain continue to climb worldwide. 1 Although chronic pain is treated with many medications, such as tricyclic antidepressants, nonsteroidal anti-inflammatory drugs, anticonvulsants, and opioids, none has shown outstanding efficacy. Narcotics are usually avoided because of the risk of developing tolerance, dependence, and functional deterioration. 2 Tricyclic antidepressants have proven efficacy in the treatment of chronic pain conditions such as diabetic neuropathy, fibromyalgia, chronic headaches, and post-herpetic neuralgia. 3 Their ability to relieve pain in these conditions appears to be independent of their antidepressant effect and may be related to their effect on neuronal reuptake of serotonin and norepinephrine. Unfortunately, side effects including dry mouth, constipation, orthostatic hypotension, and urinary retention often limit their use. CONCLUSIONS:Fluoxetine was introduced as the first selective serotonin reuptake inhibitor (SSRI) in the United States in 1988. Since then, SSRIs have become the most frequently prescribed antidepressant medications owing to their favorable side-effect profile. 4 More than half of antidepressant prescriptions written in the primary care setting are for conditions other than depression. 5 There is considerable interest in the use of SSRIs for the management of chronic pain, although they are not currently approved by the Food and Drug Administration for this purpose. This review summarizes available data on the value of these medications for pain control in several clinical situations. METHODSWe used the National Library of Medicine search engine to search MEDLINE from 1966 to 1997 using the medical subject heading (MeSH) term "pain," exploding it, and adding the following words in all fields: pain, neuropathy, migraine, and fibromyalgia. We also searched using the MeSH term "serotonin uptake inhibitors" and the following words in all fields: sertraline, paroxetine, fluoxetine, fluvoxamine, femoxetine, zimelidine, and citalopram. We combined results of these two searches with the term "and," and selected for review randomized double-blind, controlled studies published in English and performed on humans. References from studies reviewed provided additional sources of...

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“…For example, the analgesia produced by the injection of morphine into the periaqueductal gray was antagonized only by a combination of serotonergic and noradrenergic antagonists administered intrathecally (Yaksh, 1979). More recently, antidepressant drugs with serotonergic or noradrenergic reuptake inhibition have been reported to produce varying degrees of pain relief in several persistent, or chronic, pain syndromes in humans, including diabetic neuropathy (Max et al, 1992;Sindrup and Jensen, 1999), postherpetic neuralgia (e.g., Kishore-Kumar et al, 1990;Max et al, 1988), and fibromyalgia (Goldenberg et al, 1996;Rani et al, 1996). In addition, antidepressant drugs that inhibit serotonin and/or norepinephrine reuptake also have been reported to produce modest analgesic efficacy in neuropathic and inflammatory pain models in animals (e.g., Jett et al, 1997;Sawynok and Reid, 2001).…”

mentioning

confidence: 99%

Efficacy of Duloxetine, a Potent and Balanced Serotonergic and Noradrenergic Reuptake Inhibitor, in Inflammatory and Acute Pain Models in Rodents

Jones

Peters

Shannon

2004

J Pharmacol Exp Ther

149

119

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Duloxetine, a selective but balanced serotonergic and noradrenergic reuptake inhibitor, was evaluated in the acute nociceptive pain models of tail flick and hot plate in mice and in the persistent and/or inflammatory pain models of acetic acidinduced writhing in mice, carrageenan-induced thermal hyperalgesia and mechanical allodynia in rats, and capsaicin-induced mechanical allodynia in rats. In acute pain models, duloxetine had no significant effect on response latency in the mouse tail-flick test but produced modest increases in response latencies in the mouse hot plate test. Morphine produced dose-related analgesic effects in both the mouse tailflick and hot plate tests. In models of inflammatory and/or persistent pain, duloxetine, morphine, and ibuprofen produced dose-related decreases in acetic acid-induced writhing in mice. Duloxetine, ibuprofen, and gabapentin also produced dosedependent reversals of both thermal hyperalgesia and mechanical allodynia produced by carrageenan in rats. In addition, both duloxetine and morphine produced a significant reduction of capsaicin-induced mechanical allodynia in rats. Duloxetine and gabapentin were without substantial effect on the Rotorod test in mice, whereas morphine and ibuprofen produced a significant impairment. Our data indicate that duloxetine may be efficacious in the treatment of persistent and/or inflammatory pain states at doses that have modest or no effect on acute nociception or motor performance.Descending pain inhibitory circuits contribute to the supraspinal control of spinal transmission of nociceptive information. Descending inhibitory circuits include not only the neuronal connections between the ventrolateral periaqueductal gray and rostral ventral medulla but also the dorsolateral pontine tegmentum, areas that in turn project to the spinal cord dorsal horn lamina (e.g., for review, see Fields and Basbaum, 1994). The rostral ventral medulla is a primary source of serotonergic input to the spinal cord, whereas the dorsolateral pontine tegmentum (particularly the A7 and A5 adrenergic cell groups) is a source of noradrenergic input to the spinal cord. Accordingly, the serotonergic and noradrenergic systems have been implicated in the descending inhibitory control of pain in humans and animals (e.g., Fields et al., 1991). For example, the analgesia produced by the injection of morphine into the periaqueductal gray was antagonized only by a combination of serotonergic and noradrenergic antagonists administered intrathecally (Yaksh, 1979). More recently, antidepressant drugs with serotonergic or noradrenergic reuptake inhibition have been reported to produce varying degrees of pain relief in several persistent, or chronic, pain syndromes in humans, including diabetic neuropathy (Max et al., 1992;Sindrup and Jensen, 1999), postherpetic neuralgia (e.g., Kishore-Kumar et al., 1990;Max et al., 1988), and fibromyalgia (Goldenberg et al., 1996;Rani et al., 1996). In addition, antidepressant drugs that inhibit serotonin and/or norepinephrine reuptake...

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An Evaluation of Antidepressants in Rheumatic Pain Conditions

Cited by 46 publications

References 17 publications

Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis

Adverse Effects of Antidepressants for Chronic Pain: A Systematic Review and Meta-analysis

The Efficacy of Selective Serotonin Reuptake Inhibitors for the Management of Chronic Pain

Efficacy of Duloxetine, a Potent and Balanced Serotonergic and Noradrenergic Reuptake Inhibitor, in Inflammatory and Acute Pain Models in Rodents

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